Ebola

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He is going to be transported to Omaha from Liberia tomorrow. Good thing his father is a doctor / Ivy league professor of medicine.

In Spain a case now. One of the nurses that treated a infected doctor brought in from Liberia. She had supposedly only been in the patients room twice. The way this disease somehow penetrates thru modern precautions... scary stuff.

http://online.wsj.com/articles/health-c ... 1412622380

Chances are of course that for what ever reason proper protocols where not followed, or that those protocols where flawed.

You only need one to get through to start infecting others outside. Assume for a moment that nurse had a very active social life... she would not show symptoms for a week or two. That 'people arent infectious until they show symptoms' is bullcrap... they're simply less likely to infect others. This nurse wouldve gone to maybe night clubs, share restaurant food with friends, had sex with her significant other, kissed her kids, kissed her friend's kids... at work she definitely would've had physical contact with normal patients and with other nurses who in turn have contact with other patients.

Even if she did all this for say, 3 or 4 days in which 'symptoms' show up (first symptoms are mild flu like usually) this is an absolutely insane amount of people to track down and then the people those people had contact with. Its no wonder why just ONE infected individual in every US location that ebola has popped up has overwhelmed the containment effort staff and local authorities.

The government cannot and should not expect to be able to do this. Just like in the flu pandemic, the key is to have the population at large be an active partner in the process.

There already seems to be a second nurse who was infected. Alto I can not confirm it right now. But yes, no matter how she got in the first place, changes are that there could be dozens of people who need to be checked as well.

What I come away from with these incidents is that the medically advanced countries are not as prepared as they think for this disease. Yes, the protocol is known, or at least available, as are the resources, but all's it takes is one slip, one bad decision, one mistake and the virus is loose for a time.

The remote locations of the previous outbreaks in Africa although it made the deployment of medical personnel and equipment very difficult, also was an aid to keeping it contained long enough to get it under control.

When the newest outbreak surfaced in West Africa, it was from the beginning stated by the medical personnel on the spot, that it was potentially much more dangerous, because it was in a populated and internationally connected area and needed greater response and precautions. Elements of the local populace contributed to making the dangerous scenario come true, and lack of response internationally, for months, gave the virus time to multiply and spread.

Because it was not dealt with aggressively in the beginning in West Africa, is one of the main reasons it is now is showing up in other parts of the world. The sometimes long incubation period also gives the virus a sort of secret passage thru casual defenses, like a Trojan Horse computer virus.

Also it is evident you can not rely on people to follow the protocols, and some may purposely evade them in the hope of getting better medical treatment.

The protocol- and how and when to apply it- is part of the problem.

http://www.modernhealthcare.com/article ... /308219947

Here is what the CDC recommends as protocol when dealing with a known or suspected Ebola patient:



It sounds pretty comprehensive, doesn't it? But if you take a closer look at it, and compare it to the precautions being used in Liberia, it isn't. It also gives no guidance on decontamination, nor is there any recommendation that the leggings and shoe covers be fluid resistant- and they routinely aren't since they are designed for protection against airborne organisms in a not-particularly-wet medium (cough, sneeze).

Did the nurse in Spain even have that much? It's hard to know. There aren't news reports on it yet.* But I can tell you who didn't have any of that- the EMTs who answered the call for Mr. Duncan in Dallas and the staff in the ER when he arrived for the second time, vomiting. The unknown patient is a true weak link in U.S. healthcare. And the known patient with the CDC's tame precautions is also a weak link. This is a point of friction between U.S. hospitals and the CDC.



Hospitals in Europe are gearing up pretty seriously- as well they should in the wake of the Spanish nurse.

http://www.ibtimes.co.uk/ebola-outbreak ... re-1460880

On the one hand, this is not end times and there is no need to stock up on toilet paper. On the other hand, before it is fully contained, there will be other people who die from getting this outside Africa and they will probably be health care workers, just as they are in Africa. Hazmat suits or not, African healthcare workers are dying.

*found a news report: the Spanish nurse had insufficient protective equipment by WHO's guidelines. I note with disgust that her equipment does meet and even exceeds CDC's guidelines.

Last edited by Janissy on 07 Oct 2014, 1:13 pm, edited 2 times in total.

All that and more, since she was on vacation when she got symptoms.

http://www.bbc.com/news/world-europe-29514920

Just read they are going to kill the Spanish nurse's dog. ???? A septic bath yes, and perhaps quarantine, but euthanize when there is no evidence that dogs can get the disease? Its over-reaction stupidity and cruel as the nurse and her husband of course do not want them to do it.

Oh no
I googled and here's the story:

http://www.nbcnews.com/storyline/ebola- ... la-n220361

Why not quarantine????

It's not bs that ebola can't spread while incubation, saying that shows you have a fundamental misunderstanding of how this virus works and transmits itself. People that have direct contact with the infected or dead are those at risk of this and health care workers are probably the single most vulnerable group to this.

Some of the empirical claims about Ebola, being made by medical organizations and governments do not have sufficient scientific evidence to back up the statement that it is totally impossible. Those specifically being that you can not contact Ebola by airborne transmission or when a person is asymptomatic.

Airborne transmission in particular is hotly debated at the moment, with more experts coming out and saying we do not in fact really know, and there is evidence and unsolved/undetermined cases enough to be very concerned and take precautions against airborne transmission. The idea that Ebola could in fact be transmitted thru coughs and sneezes is the main worry.

Ebola is already known to be in a persons mucus/sputem. Other strains of Ebola have been shown to be airborne transmitted between monkeys. In previous outbreaks there were cases where direct contact with fluids could not be established and had to be categorized as unknown method of infection.

I can't say one way or another, but would say they had best treat it and take preventive measures as potentially airborne transmittable until they do in fact know for sure one way or another. If there was ever a time to follow the adage 'better safe then sorry' it is with this disease.

Oh, and for those of you interested in the dog of the infected nurse they are planning to euthanize in Spain, here is the online petition to quarantine the dog instead. 300k + signatures already! The dog is a mixed breed named Excalibur:

https://www.change.org/p/a-los-que-sea- ... crificarlo

There is also Twitter and Tumbler stuff, but I know nothing about how those networks work. A Twitter hashtag being used is: #SalvemosAExcalibur

There was a study done concerning whether dogs could contract or transmit Ebola. The results were not conclusive as none of the dogs tested had Ebola in there system. But a fair percentage of dogs (5-30%) living in the affected villages showed markers in their system that are associated with exposure to Ebola. It got too technical for me, but it sounded like immune response stuff. The researcher(s) concluded more study was necessary but that dogs, and possibly other pets could not be ruled out as carriers.

In Excalibur's case then I think quarantine and study is the best approach. It will benefit the recovery of the infected nurse and her family (husband under quarantine) to know their loved pet will not be killed needlessly and be given the same chances as them. Something may be also learned from studying the animal.

^^^^^

Yes absolutely. Maybe calmer heads will prevail and they will realize how much there is to be gained from quarantining rather than killing him.


Remember Hurricane Katrina and how many people didn't evacuate because they couldn't take their pets and they would rather have faced the wrath of the hurricane than lose their pets? That is yet another reason to quarantine rather than kill him. His death would give other exposed or infected pet owners an incentive to delay their own treatment or to smuggle their pet somewhere else before seeking treatment.

I signed the e-petition. Hopefully a very large number of signatures will be a red flag to authorities at how many people would go to lengths to make sure their pet isn't killed if they are ever exposed. Delaying treatment, smuggling the pet out before getting treatment, letting the pet loose somewhere else are real possibilitites.


I have also noticed a disconnect between what doctors in the field and ebola researchers say and what heads of organizations say. The heads of organizations are charged with containing public panic as well as containing the virus so "don't worry" pronouncements are to be expected. But the people who have at some point in their career worn gloves contaminated with ebola virus are a lot less confident about what we know for sure.

Here's the study.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298261/

Here's the scary part:



Here's the not-scary part:


So dogs are able to be infected but asymptomatically and can transmit virus during a window of unspecified but short time before clearing it. That seems like a very good reason for quarantine of Excalibur. They can find out if he has an asymptomatic infection (he might not!) and exactly how long he sheds virus before clearing it.

I find it a little odd that dogs are considered a potential vector of asymptomatic transmission but humans aren't. The human equivalent of licking would be kissing. All googles of human transmission emphasize that it can't be transmitted before a human shows symptoms. But I can't find any actual studies of whether the saliva of an asymptomatic (or pre-symptomatic) human contains virus the way it does in a dog (per that one study). Is the idea that it can't be transmitted prior to symptoms based purely on the observation that it doesn't have airborne transmission? Or is it based on actual studies that people don't shed virus until they start showing symptoms? I can't find studies on that. Maybe they are being done right now on the people Duncan contacted.

Texas ebola patient has died.
Will this help discourage other Africans from attempting to come to America for treatment?
The most cynical part of me wonders whether he was let die for that reason.